Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Asthma - Management
Children under 5 years of age with uncontrolled symptoms on current treatment: How do I manage?

  • Adjust treatment using the step-wise approach outlined below.
  • Before starting a new drug or stepping up treatment, confirm with the parents their understanding of the role of treatment, adherence to treatment, inhaler technique, and appropriate elimination of trigger factors.
  • Choose an effective delivery system on the basis of convenience, cost, and suitability:
    • Step 1: Prescribe a short-acting beta2-agonist to all children, for rapid symptom relief.
    • Step 2: Consider starting an inhaled corticosteroid (ICS) at a dose that is appropriate for the severity of symptoms (usually equivalent to beclometasone CFC-free as Clenil Modulite® 200 to 400 micrograms/day). Indications for ICS include:
      • Having symptoms three times weekly or more, or
      • Awakening with symptoms one night weekly or more, or
      • Having an exacerbation in the last 2 years, or
      • Using inhaled short-acting beta2-agonist three times weekly or more.
    • If ICS are not tolerated or are contraindicated, consider starting a leukotriene receptor antagonist at step 2 (but do so only in children aged 2–5 years).
    • Step 3: If the child still has symptoms while using regular ICS (equivalent to Clenil Modulite® [beclometasone CFC-free] 400 micrograms/day), consider:
      • For children younger than 2 years: move to step 4.
      • For children aged 2–5 years: initiate a trial of a leukotriene receptor antagonist; if asthma remains inadequately controlled, move to step 4.
    • Step 4: Refer to a paediatrician with knowledge about respiratory diseases.
  • Offer self-management education, including written action plans focusing on the child's and the family's needs.

In depth

© NHS Institute for Innovation and Improvement